Mosquito Bites

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Dr. Greene, my 8-year-old daughter has had a problem with mosquito bites for as long as I can remember. Our physician hasn’t had any answers or treatment ideas (rather than to stay indoors). When Lauren is first bitten the bite appears normal, but given a few hours it can turn the surrounding area hot, red and the whole area becomes inflamed — at times as big as an orange. She gets a blister where the bite initially took place. She often runs a low grade fever with the bites and develops bruises in the area. Our doctor assures me that it is nothing more than an allergic reaction to mosquitoes, but says there is no treatment. I have heard that taking garlic pills can help repel insects. Insecticides haven’t done much good. What can I do to at least treat her symptoms when bitten? Thanks,Cynthia Reamers – Douglas, Arizona

Dr. Greene`s Answer:

Cynthia, I now receive many questions each week from around the world. While I can’t possibly answer all of them, each question does make a difference. One of the unforeseen results of this website for me is being able to watch clusters of concerns arise from people who don’t even know each other. This week, I’ve received a flood of questions about mosquito bites. Those fragile little insects can be quite a nuisance. Your daughter Lauren suffers much more than most, and I trust we’ll be able to give her some relief.

Mosquitoes wouldn’t be such a problem if it weren’t for the blood-sucking habits of the females. The males (and often the females) feed on plant nectar, but the females also depend on a blood meal to get the protein they need to mature their eggs, which they then lay on the surface of still water.

Mosquitoes are delicate little insects with long, fragile-looking legs and mouthparts. Appearances deceive, however — the female is equipped with blade-like, piercing mouthparts that enable her to get what she needs for her babies.

Meanwhile, mosquitoes are known to pass blood-borne illnesses from one victim to another. They are a major health hazard and are responsible for the transmission of yellow fever, malaria, dengue fever, encephalitis, and many other serious diseases. In parts of the world where mosquito-transmitted diseases are not common, it is the bite itself which presents the greatest difficulty. More infants and children are bitten by mosquitoes than by any other insect.

When the mosquito stabs her needle-like mouthparts through the skin of her victim, she injects her saliva — teeming with digestive enzymes and anticoagulants. The first time a person is bitten, there is no reaction. With subsequent bites, the person becomes sensitized to the foreign proteins, and small, itchy, red bumps appear about 24 hours later. This is the most common reaction in young children. After many more bites, a pale, swollen hive, or wheal, begins to appear within minutes after a bite — followed by the red bump 24 hours later. This is the most common reaction in older children and adolescents.

With repeated mosquito bites, some people begin to become insensitive again, much as if they had allergy shots. Some older children and adults get no reaction to mosquito bites (unless they go for a long time without being bitten — then the process can start again). Other people, like your daughter Lauren, become increasingly allergic with repeated stings. They can develop blistering, bruised, large inflammatory reactions. For these people, avoiding being bitten is a particularly good idea.

Mosquitoes are attracted to things that remind them of nectar or mammal flesh. When outdoors, wear light clothing that covers most of the body, keeping as much of the skin and hair covered as practical. Avoid bright, floral colors. Khaki, beige, and olive have no particular attraction for mosquitoes. They are also attracted by some body odors, and for this reason they choose some individuals (me!) over others in a crowd. Avoid fragrances in soaps, shampoos, and lotions. All other things being equal, mosquitoes will choose children as their victims rather than adults. Many species of mosquito prefer biting from dusk until dawn. The problem is worse when the weather is hot or humid. Avoid playing outdoors during the peak biting times in your area. It would, of course, also help for one to stay away from still water. People who are highly allergic should avoid vacationing in the Everglades.

The Centers for Disease Control and Prevention (CDC) recommends using an insect repellent on exposed areas of skin. The most effective compounds are DEET (N,N-diethyl meta-toluamide), picaridin, and oil of lemon eucalyptus (Repel). I prefer the safe, non-toxic, plant-based oil of lemon eucalyptus. It does cause irritation if it gets in the eyes, but has otherwise proven safe. It has not been tested, though, on children under age 3. DEET-containing products should not be used on children under 2 months of age. Don’t apply repellents under clothes, or too much may be absorbed. Also, avoid applying repellent to portions of the hands that are likely to come in contact with the eyes and mouth.

30% is the maximum concentration of DEET recommended for infants and children. Lower concentrations have not been shown to be safer. The concentration of an insect repellent affects how long it will last, not how effective it will be when applied.

I prefer gentler insect repellents for children.

Other ingredients, such as IR3535 (Avon-Skin-So-Soft) or combinations of plant oils (Bite Blocker Xtreme or Burt’s Bees All Natural Herbal) can prevent bites, but not as effectively as DEET, picaridin or oil of lemon eucalyptus.

Repellents may not stop mosquitoes from landing — only from biting. If you see mosquitoes on Lauren, the repellents may still be working. If, however, Lauren is being bitten, they are not working.

Some studies suggested that taking thiamine (vitamin B1) 25 mg to 50 mg three times per day was effective in reducing mosquito bites. This safe vitamin was thought to produce a skin odor that is not detectable by humans, but is disagreeable to pregnant mosquitoes (Pediatric Clinics of North America, 16:191, 1969). It seemed to be especially effective for those people with large allergic reactions. Thiamine takes about 2 weeks before the odor fully saturates the skin. Subsequent studies have not found this to be effective. Some say that garlic may work in the same way (except, of course, the odor is detectable by humans), but I have seen no scientific studies supporting this. One recent study was unable to demonstrate that garlic was an effective mosquito repellant (Med Vet Entomol, 2005, 19(1)84-9.)

Once bitten, the mainstays of treatment are cool compresses, antihistamines, anti-itching compounds, and anti-inflammatory medicines. For a cool compress, apply an ice pack wrapped in a towel or soak a washcloth in cold water and press it on the bite. Ask your pharmacist to help you select an appropriate antihistamine for your child. Some are available by prescription only. You might have to balance strength versus drowsy side effects. Zyrtec, a newer antihistamine for children (available over the counter), usually works very well while not being very sedating. Of course, sometimes sedating is not such a bad thing…

The simplest anti-itching compound is a paste made of baking soda and water. Use just enough water to make a sticky paste, and spread it on. Calamine lotion works in a similar way, and usually the effect lasts longer. Other children prefer a menthol lotion such as Sarna. A topical anesthetic containing pramoxine (such as the prescription PrameGel or the over-the-counter Caladryl) can take away the pain and itching.

For the anti-inflammatory part of treatment, ibuprofen (Motrin or Advil) or naproxen (Aleve) can reduce redness, pain, itching, swelling and fever. Topical steroid creams of various strengths can also be useful. Occasionally, reactions to mosquito bites can be severe enough to warrant systemic steroids.

Studies suggest that some natural anti-inflammatory remedies are very effective in some people: oral evening primrose oil (Lancet, 2:1120, 1982) and papaverine (Journal of the American Academy of Dermatology, 13:806, 1985). You might find both of these in a health food store.

Stronger, experimental treatments include thymic hormones, recombinant gamma interferon, ultraviolet radiation, various chemotherapeutic agents, and immunotherapy with mosquito extract (Clinical Pediatric Dermatology, Saunders 1993, Ann Allergy Asthma Immunol, 2007 Sept:99(3):273-80), but I would only consider them if Lauren’s reactions get much worse. Probably they will instead get better over time.

It’s tempting to view mosquitoes as nothing but pests. But as my dear friend Christine Du Bois-Buxbaum reminded me, there are species of fish in the Everglades that need mosquito eggs for their diet. These fish are in turn important to the food chain in their own ways. So, although mosquitoes have been a health problem for centuries, they are also an important part of the Everglades ecosystem and of other natural habitats. Widespread destruction of mosquitoes isn’t necessarily the answer.

Still, buzzing mosquitoes are the bane of warm summer evenings. I’ve given you a lot of different solutions. You won’t need to use them all, but you may need to try several before you find what works best for Lauren. I trust you’ll soon be able to enjoy outdoor time together this summer. And autumn is just around the corner.

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

7 Comments

Leona K

I appreciate the Dr advice but I suffer from the same problem with mosquitos & the only thing that helps me is apple cyder vinegar & lemon juice. Every moring I put two tea spoons of ACV, two table spoons of lemon juice & 2oz of water in a cup mix it & knock it back. Idk why it works, but it does. I went from getting bit 15 times a day to maybe 15 the whole summer. Good luck.

Added:
March 12, 2015

That’s so interesting. I think (reminder, I’m not a doctor) mosquitos are drawn to the odor of some people more than others. When our family goes outdoors two of us are bitten far more than the others. I bet you’re changing your scent, and the mosquitos don’t like it. I’m going to give it a try the next time we’re going camping.

Added:
March 12, 2015

Trina D

Just this summer I began getting lots of mosquito bites that became inflamed. I can’t even remember the last time I has a mosquito bite which I why I’m assuming I am super allergic to them now. I have gotten at least 10 huge, inflamed mosquito bites in a month and a half… crazy! One even came with a bacterial infection which was treated quickly with antibiotics. My most recent bite is 3.5 inches in DIAMETER… huge, hot, and annoyingly painful! Regular hydrocortisone creams do not work on me any more nor does it cool it… I feel it has irritated it a little more. I’ve found only 2 things that have worked for me as a 26 yr old adult:
1. My good friend introduced me to this thing called Redmond Clay. She applied a thick layer onto a bite on my hand. The bite had my whole hand swollen where you couldn’t see my knuckles. After an hour of applying the clay, the swelling went down drastically (I’d say 90%) cooled the hot inflamed area, and was therefore less painful from the swelling. It supposedly pulls out toxins. You can buy Redmond Clay on Amazon, not sure if they sell in stores. It is magic and carry it with me all the time now! Very good for mommies =]
2. My grandma swear vinegar works for all sorts of things including any kind of bug bites. I’ve read online many say only apple cider vinegar works. I never believed my grandma but I was desperate waiting for the Redmond Clay to arrive. I dunked my swollen hand into a cup of regular white vinegar (didn’t have apple cider vinegar) for a few seconds to minute (keep in as long as you like) and rinsed with cold water. Surprisingly, it helped cool the burning and itching and helped reduce the swelling. Amazing!
So I now alternate dipping bites into vinegar and applying the Redmond Clay. I love using these 2 solutions because they are way more natural than using all those medications and OTC drugs.

Added:
October 13, 2014

Brianna

I get bites on my legs and i have two right now on my shin on one leg and and one on the side on the other. I’ve gotten them a long time ago andnow they are bruises, small ones. They bother me a lot and it’s so visible I don’t like wearing short pants to school because of them. They look like they have been bumped slightly, like a small scab. The bruise is still there after about 2-3 months. Any remedies that would work for this or am I stuck with it forever?